By: Julia Wheeler
Journal of Global Rights and Organizations and Impunity Watch News
Medmoune v. France arises out of doctors’ decision to withdraw life-sustaining medical treatment from patient “A.M.”. This decision was made despite A.M.’s drawn up advance directives, which stated his wishes for the continuation of life-sustaining treatment, even in the case of permanent loss of consciousness and ability to communicate. This raises the legal question of whether this decision was a violation of Article 2 (right to life) of the European Convention on Human Rights.
Background – Bruay-sur-l’Escault, France:
In May of 2022, A.M., a 44-year-old male, was run over by a commercial vehicle that he was repairing. He suffered severe trauma, including cardiorespiratory arrest and prolonged oxygen deprivation. A.M. was admitted to the Valenciennes Hospital ICU, where it was determined that he no longer had brain-stem reflexes or brain activity and had sustained anoxic injuries.
On May 31, 2022, pursuant to Article R. 4127-37-2 of the French Public Health Code, the hospital began its collective procedure, the process doctors follow when deciding whether to limit or withdraw treatment. On June 1, 2022, the doctors decided that treatment would be withdrawn on June 9, 2022. The applicants challenged this decision, and before the withdrawal date on June 8, 2022, the Lille Administration Court suspended it. Revisiting the decision on July 15, 2022, the head of the ICU again decided to withdraw treatment on July 22, 2022. The applicants again challenged this through an urgent application for protection of a fundamental freedom, which the Administrative Court dismissed on July 22, 2022.
The applicants appealed to France’s highest administrative court, the Conseil d’État, seeking review of the constitutionality of the legal provision authorizing the hospital’s decision. The Constitutional Council upheld the constitutionality of the provision on November 10, 2022, and the Conseil d’État dismissed the applicants’ action.
As a final recourse, the applicants requested an interim measure from the ECHR under Rule 39. They hoped to be granted a stay of execution of the July 15, 2022, decision, and continuation of treatment while their case was pending. The judge denied the applicants’ request.
Treatment was withdrawn on December 26, 2022, and A.M. passed away that day.
Applicants’ Claim/Argument
The applicants claimed that A.M.’s right to life under Article 2 was violated, as was his right to respect for private life under Article 8, and his freedom of thought, conscience, and religion under Article 9 of the Convention.
They criticized France’s Public Health Code for permitting doctors to override patients’ advance directives deemed “manifestly inappropriate,” arguing that this grants excessive discretion to doctors which in turn creates a risk of arbitrary interference with Convention rights.
Decision
The Court upheld the French legislation framework as compatible with Article 2. Under the Convention, States have the discretion to determine which factors to consider and how to weigh competing rights and interests.
The Court acknowledged that the doctors were initially unaware of A.M.’s advance directives. After reviewing them, the medical team concluded that following the directives was not compatible with A.M.’s medical condition, and that continuing treatment would be considered “unreasonable obstinacy,” meaning it would provide the patient with no real benefit. The team also considered the family’s objections but decided that these could not override their medical judgment. The Court found that A.M.’s wishes were properly considered throughout the process.
The Court found that the State had provided the applicants with prompt and reasonable judicial remedies, which considered various factors, such as medical evidence and A.M.’s advance directives. Therefore, the State has complied with its positive obligations under Article 2 of the Convention.
The Court referenced prior rulings to reiterate that while Article 8 protects personal autonomy, it does not bind States to advance directives, as they may utilize their discretion. On this basis, the Court found the French framework compatible with Article 2. Further, the Court held that applicants’ Article 9 complaints were sufficiently addressed by its Article 2 analysis.
Significance
This case is the first before the ECHR where it involves not a patient’s advance directives to withdraw life-sustaining medical treatment, but their directives to continue the treatment.
For further information, please see:
Judgment Medmoune v. France – Press Release Issued by the Registrar of the Court
Public Health Code: Article R. 4127-37-2
